Labor and Delivery Services:You are the new manager of the Social Services Department of a small, 18-bed rural hospital within the Bright Road Health Care System. As a member of the ethics committee f

Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 1 Equipment Purchase Introduction: You are the C hief Financial Officer (CFO) of a small rural women’s health center within the Bright Road Health Care System. As CFO, you will review a proposal to purchase a 3D mammography machine for the women’s health center and will discuss the issue with a physician, the chairman of the Board of Directors and the Director of Nursing to understand all costs and benefits of this purchase . You need to consider finance, authority of the Board of Directors, public relations/marketing, wishes of medical staff, needs of the community, and future implications when making your decision whether to purchase the equipment. After gathering the info rmation, y ou will submit your decision , along with your rationale, to the Board of Directors . Characters: 1. Thomas Jenkins , Physician at the Women’s Health Center 2. Maria Vasquez , Director of Nursing at the Women’s Health Center (case management) 3. Quinn Smith , Chairman of the Board of Bright Road Health Care System Locations: 1. CFO’s Office 2. Hospital Corridor 3. Conference Room (Women’s Health Care Facility) 4. Chairman of the Health Care Board’s Office Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 2 Scene 1: Planning Your Day In this scene, the student /CFO begins their day in their office. The CFO begins by looking at the day’s appointments and checking email to establish the case, namely that the CFO will need to determine whether to recommend purchasing mammography imaging equipment. Location CFO’s office Scene setup The student is looking at their computer On -screen characters None Off -screen characters N/A On -screen text: Good morning and welcome to the office! Take a look at your calendar to see what meetings you have lined up for the day. Note: A compu ter hotspot flashes on screen for student to click. On -screen text: You’ve got a busy day lined up! You’d better check your email now, before things get too hectic. Note: A computer hotspot flashes on screen for student to click. EMAIL FROM HEALTHYTECH CORPORATION Dear Chief Financial Officer, Thank you for contacting us about our range of health care equipment solutions. Here is the quote of the equipment that you have requested. HealthyTech 3D Digital Mammography Imager: $500,000 Our Mamm ography Imager is the most advanced and current imaging technology available. By purchasing the Imager, you would allow the Bright Road Health Care System to offer a valuable service to your community and would improve your community’s chances in the figh t against breast cancer. We have several financing options available if cost is a concern; please feel free to contact me with any questions. Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 3 Regards, Steven Archibald HealthyTech Sales Manager On -screen text: $500,000 is a large investment, especially when the future of health care funding is so unpredictable. It looks like you’ve got another unread email. Note: An email button flashes on screen for student to click. EMAIL FROM QUINN SMITH Good morning, I’ve spoken to the Board about the possibility of making new capital purchases and the Board is very reluctant to make large purchases in medical technology, especially if the services are available at another facility. Overall, the Board is worried about both state and federal health care legislation a nd how that will impact Bright Road’s bottom line. We can talk more about this at our meeting this afternoon. If you’re recommending a large equipment purchase, the Board needs to understand why this is absolutely necessary and how Bright Road is going to benefit. Quinn Quinn Smith Chairman Board of Directors, Bright Road Health Care System On -screen text: Looks like you’ll need to do some more research on this. A good place to start would be talking to Thomas Jenkins, the physician who suggested this purchase in the first place. Note: Add cell phone button on screen On -screen text: Send a text message to Thomas Jenkins to see if he’s available to talk about why he wants the health center to buy this equipment. Note: Make cell phone button flash for student to click on, make student click screen after each text message is read . Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 4 CELL PHONE SCREEN STUDENT OPTION Good morning Thomas, do you have time today to discuss the mammography imager? THOMAS JENKINS TEXT RESPONSE Yes, I have a few minutes right now before my appointments start. I’ll meet you on the way. STUDENT TEXT RESPONSE Great, see you in a minute. THOMAS JENKINS TEXT RESPONSE Sounds good. END OF SCENE 1 Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 5 Scene 2: Discussion with Thomas Jenkins , M.D. In this scene, the student talks to Thomas Jenkins in order to assess why the medical staff is requesting the purchase of a mammography imager. Location Hospital Corridor Scene setup The corridor is empty, Thomas Jenkins walks in from right side of scre en On -screen characters Thomas Jenkins Off -screen characters N/A On -screen text: Thomas should be here any moment. Taking notes about your conversation will help when making your recommendations later! Note: Thomas walks on screen from the right side of screen THOMAS Hi, thanks for texting me. How are you? STUDENT I’m doing well . Busy, huh ? THOMAS Very busy today, I’m sorry that I only have a few minutes to talk but it’s important for Bright Road to get this upgrade. State of the art technology like this made a positive impact at the hospital where I previously worked . STUDENT That’s why I’m glad you had a minute to talk. I’ve been researching this equipment but I don’t understand why it’s absolutely necessary to make this purchase now. THO MAS Well, a t the hospital I worked at before Bright Road, we had a 3D imager and we were able to detect breast cancer much earlier than we had been able to before. Student may choose either option to proceed. STUDENT OPTION 1 How does that affect treatment? ** STUDENT OPTION 2 Why is early detection so important? THOMAS RESPONSE When you detect breast cancer earlier, it’s easier to treat and there’s a better chance of a positive outcome. Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 6 Student m ust choose correct option to proceed. STUDENT OPTION 1 (INCORRECT) Why does the medical staff want to have a 3D imager here? STUDENT OPTION 2 (CORRECT) Why can’t we refer our patients to medical care facilities that have this technology already? THOMAS RESPONSE 1 I think that it’s obvious that our staff wants our patients here to have the best possible care, and that includes preventive care like this. THOMAS RESPONSE 2 Our mission as a women’s care facility is to provide the best possible care to women in our area. If we don’t provide 3D imaging to our patients and refer them to other facilities, it’s a slippery slope for Bright Road to walk down. Would we recommend our patients go to another facility if our x -ray machine went out? I know it’s kind of an absurd example, but one that we n eed to think about when we consider our responsibility to the community. Student must choose all options to move to the next question . STUDENT OPTION 1 Did your previous employer’s contract with the vendor include upgrades to the technology? STUDENT OPTION 2 Do insurance companies provide increased reimbursements for 3D imaging? STUDENT OPTION 3 What is the error rate for 3D imaging? THOMAS RESPONSE 1 I’m not sure. You might want to contact a few vendors to find out. THOMAS RESPONSE 2 No, as far as I know, the insurance companies have just been providing the same reimbursement rate as with traditional 2D imaging. At the AMA convention last year, I had heard from some colleagues that some of their hospitals were charging an additional $50 for 3D imaging. Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 7 THOMAS RESPONSE 3 There’s a 7% improvement in cancer detection when you use both 2D and 3D image s together. When using the traditional 2D imaging, you have a 10% false positive rate. STUDENT Wait, so you use both the 2D that we currently have and a 3D imager together? THOMAS Yes, at my previous hospital we were using both together. The FDA has only approved 3D as an add -on, not a replacement for 2D imaging, probably because the technology is so new. ( Thomas looks at his watch) Listen, I h ave to run, I have an appointment that I’m late for, but let me know if you want to talk about this more. I’ll see you later. STUDENT Thanks for talking to me about this. END OF SCENE 2 Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 8 Scene 3: Equipment Purchase After speaking to Thomas Jenkins about the purchase of the mammography equipment, the student realizes that they need more information from the vendor. In this scene, the student will select questions to send in an email to the vendor to get better inform ation about the equipment. Location CFO’s office Scene setup The student is looking at the computer On -screen characters None. Off -screen characters N/A On -screen text: Well, it looks like you’ll need more information from the vendor. Reply to the HealthyTech Sales Manager and ask more questions about the 3D Mammography Imager. Note: An email button flashes on screen for student to click. EMAIL TO HEALTHYTECH CORPORATI ON Dear Steven Archibald, Thanks for sending the quote for the HealthyTech 3D Digital Mammography Imager. I have a few more questions about this technology. On -screen text: Select questions from the following list to include in your email to Steven Archibald. Think about your conversation with Thomas Jenkins and address the questions that arose. Click "No more questions" when you have finished asking all of your questions . Note: Student must select at least Options 1, 2 and 3. If student does not select 1, 2 and 3, student will be kicked back to select more options before proceeding when clicking the “ No more questions" button. STUDENT OPTION 1 Is the 3D imager intended to be a replacement of our current 2D mammography machine? STUDENT OPTION 2 What is the reimbursement rate from insurance companies when billing for this service? Do any of your clients charge their patients a premium for 3D imaging? STUDENT OPTION 3 Wh at happens if there is a major advance in this technology next year? If we bought a 3D imager from HealthyTech, is there a guarantee that you will provide technology upgrades or is that provided at an additional cost? Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 9 STUDENT OPTION 4 What kind of financ ing is available? Can we lease the imager? STUDENT OPTION 5 What is the error rate for 3D imaging? If options 1, 2 and 3 selected, an email Send button flashes on screen after click of "No more questions" button. ON -SCREEN TEXT FOR INCOMPLETE I don’t think that you’ve asked enough questions yet. Remember, you’re trying to get information about the equipment so you can determine whether it’s a good investment. Better select one or two more. ON -SCREEN TEXT FOR COMPLETE Great! This information will be very helpful as we keep going. On -screen text: Looks like you’re getting a text message! Better answer it. Note: Make cell phone button flash for student to click on, make student click screen after each text message is read CELL PHONE SCREEN: MARIA VASQUEZ TEXT Hi, it’s Maria, are we still on for this afternoon? STUDENT TEXT RESPONSE Absolutely! 1:00, right? MARIA VASQUEZ TEXT RESPONSE Yes, 1:00. See you then. STUDENT TEXT RESPONSE Great, thanks Maria! Note: Make cell phone OFF button flash for student to click on to close phone graphic Note: An email button flashes on screen for student to click. Email includes responses to questions clicked on by student in the email sent previous to text message. EM AIL FROM HEALTHYTECH CORPORATION Hello, Thanks for writing, I’m happy to answer your questions. (RESPONSE 1) While we believe that the 3D mammography imager is capable of providing an accurate diagnosis, the FDA has not yet approved its use without a Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 10 concurrent 2D mammography. (RESPONSE 2) Regarding reimbursement rates, we recommend contacting insurance companies that you currently work with to answer that question. Unfortunately, we can’t provide you with information about specific clients, but yes , some do offer to provide 3D mammography imaging for an additional fee. (RESPONSE 3) You’re right, the 3D mammography imaging technology is moving very quickly . Our engineers plan for that as best they can, so that if you buy a 3D imager from us, we’ll p rovide software updates and a warranty, but you will still have to pay for regular maintenance, much like when you purchase a car. (RESPONSE 4) As far as financing goes, we do have several banks that we work with to provide financing . I can set up a mee ting with our preferred lenders, although I’m sure that Bright Road has its own banking preferences and relationships built. We are unable at this time to offer our 3D imagers for lease. (RESPONSE 5) The error rate for 3D imaging is very low, as low as 5 .2% for technologists who have a lot of training and experience. This translates into fewer requests for retesting and much lower stress for your patients. If you need anything else, please don’t hesitate to ask, we want you to be happy with your decisio n. Regards, Steven Steven Archibald HealthyTech Sales Manager Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 11 Note: An email close button flashes on screen for student to click. On -screen text: Wow that was a fast response! Looks like Thomas has his facts straight. You’d better get moving, you don’t want to keep Maria Vasquez waiting. END OF SCENE 3 Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 12 Scene 4: Meeting with Maria Vasquez , R.N. In this scene, the student speaks with Maria Vasquez, the Director of Nursing at the Women’s Health Center to assess the needs of the community, future implications and possible public relations and marketing strategies centered around offering 3D mammography services at the Center. Location Conference Room (Wome n’s Health Care Facility) Scene setup Conference Room has Maria Vasquez sitting at the table On -screen characters Maria Vasquez Off -screen characters N/A MARIA Hi! How’s your day going? STUDENT Oh, very busy! I’m trying to get all of the information I can about the 3D mammography imager, and everyone’s input on what this will mean for us here at Bright Road. MARIA Well, I am supportive of us getting this 3D technology here. You spoke to Dr.

Jenkins about this already, right? He used to work at a hospital that had an imager and he said that it really was helpful in catching breast cancer early. STUDENT Yes, I just spoke with him earlier today. He mentioned that there was a lower error rate with this kind of technology. MARIA I can’t begin to tell you how much that means to a cancer survivor like me. When I was diagnosed, my mammogram wasn’t conclusive and I had to go back for two additional mammograms before running tests. Just not knowing whether or not you have breast cancer and c ontinuing for weeks with these tests is incredibly stressful and really takes its toll. If this 3D technology can eliminate that stress for our patients who aren’t cancerous but would have to return for more tests, it would be worth it. Student must choo se both options to move to the next question. STUDENT OPTION 1 I’m sure that’s true. I’ve heard that other hospitals are charging a premium to offer 3D mammography imaging to patients. Do you think that our patients will pay an additional fee for this service? STUDENT OPTION 2 Good point. So, h ow are we going to tell our patients and the community that we’re offering 3D mammography imaging? Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 13 MARIA RESPONSE 1 I’m really against charging a high additional fee for 3D imaging. It puts up a barrier between the highest quality care and the patient. We have a responsibility to provide the best care to all of our patients. I think that a lot of our patients will pay for this additional service, as long as it’s not too high a fee. I’d really prefer to have our patients not have to make receiving the best possible health care a financial decision if we can help it. MARIA RESPONSE 2 If the Center decides to buy this equipment, I’ll be sure to begin telling my women’s health groups ab out it and all of my patients. We have a database of all our current and former patients and I can draft an email announcing when we’ll be offering the service. Our database is really great too; we can target patients in different age groups as well as t hose patients who are due to come in for a mammogram. Student must choose all options to move to the next question. STUDENT OPTION 1 Would it be feasible to recommend that our patients drive to the city to get this procedure done? STUDENT OPTION 2 How would we market this to our patients? STUDENT OPTION 3 Can the 3D save costs? MARIA RESPONSE 1 A lot of our patients aren’t able to go to the city for medical procedures. The city’s over an hour’s drive away, and if you don’t have a car, it takes nearl y the whole day to get there and back by bus. We really owe it to our community to provide the best possible care to them within reason. Buying a 3D imager is within reason for a modern health care facility. MARIA RESPONSE 2 There are a number of different ways that we can market this. Of course, we can use our website and our presence on social media to make sure that all of our friends and followers on the internet know that we’re providing the best possible service. We could take out a few pri nt ads as well and suggest to Bright Road’s corporate office that they could use our Center’s acquisition of a 3D mammography imager in a national ad campaign to show how Bright Road is addressing the needs of the communit y. Just off the top of my head, i f we absolutely have to charge a fee for this service, we could run a discount during Breast Cancer Awareness Month. Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 14 MARIA RESPONSE 3 When you catch breast cancer early, available treatments are much less invasive. Generally, the more invasive the trea tment, the more expensive it is for both the patient and the health care provider. I don’t know how many patients will be able to avoid more expensive procedures, but there will be savings. STUDENT I understand that 3D imaging isn’t allowed by the FDA t o be used as a standalone procedure. Why can’t we wait to buy one until the FDA approves use as a replacement for the 2D machines that we already have? MARIA: You could make that argument for buying any tech equipment. Why buy a new computer to replace the one you have now when you know that next year, there will be a better one? The bottom line is that we should be providing the best health care possible and a 3D mammography imager falls into that category. Student can choose either option to continue. STUDENT OPTION 1 Maria, I’m not sure I know where you stand on this issue. Should we take more time to think about this? ** STUDENT OPTION 2 You make a great point. Well, I think that I have a pretty good sense of how you feel about this! MARIA (laughs) Yes, I’m sorry, I don’t mean to be pushy, I just really believe that buying this 3D imager would be great for us and would benefit the community. Just the fact that we’re offering a service that’s currently only available in more affluent an d urban areas of our state will be positive for the Center as a whole, both for the bottom line and for patient outcomes. It’s definitely worth the cost. STUDENT Tha nks so much for taking the time to speak with me, this has been really informative. I ha ve to run to go talk to the Chairman of the Board, is there anything else that you’d like me to know about? MARIA Just one more thing. I think we need to consider the physicians. We have two new doctors on our staff, coming from residency programs where they had the 3D Imager. If they do not feel their requests are being heard and they do not get equipment that they think is crucial to their job, they might just leave. After all, they have been here less than two years and do not have deep ties to the community. Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 15 Student can choose either option to continue. STUDENT OPTION 1 Thanks Maria, I’ll talk to you later. STUDENT OPTION 2 Maria, I don't know that I agree that the physicians should have a big say in the purchase, but I really appreciate you taking the time to talk to me. MARIA Anytime, I’m happy to help out wherever I can! END OF SCENE 4 Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 16 Scene 5: Discussing Capital Ex penditures In this scene, the student talks to Quinn Smith, the Chairman of the Board at Bright Road. The student will ask about the Board’s position on major capital purchases, the financial impact of buying a 3D imager, and how the return on investment factors into the Board’s decisions. Location Chairman of the Health Care Board’s Office Scene setup Chairman’s office has Quinn Smith standing On -screen characters Quinn Smith Off -screen characters N/A On -screen text: Lastly, you’re meeting with Quinn Smith, the Chairman of the Health Care Board’s Office. Be sure to take good notes! QUINN Good to see you . Ho w is everything in the Finance department? STUDENT We’re doing well, keeping busy for sure. How was the last Board meeting? QUINN Well, it’s always interesting, I’ll give you that. Between trying to predict what the Feds are going to do next year with health care reform and trying to plan for the future of all of the healthcare centers we operate, it’s a miracle we’re able to keep members on the Board trying to handle everything. STUDENT Wow, it sounds like you’ve got a lot on your plate. QUINN You co uld say that. In addition to all that, we have to see that our shareholders are turning a profit , while simultaneously ensuring that we’re making people better. STUDENT Well, that’s why I wanted to speak with you this afternoon. The physicians and nurse s at the Women’s Health Center are pushing for us to buy a 3D mammography imager. QUINN That sounds expensive. I think that I read about these in the New England Journal of Medicine. They’re supposed to complement the ones we have, right? Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 17 Student must select correct option to continue. STUDENT OPTION 1 (INCORRECT) I think that it’s a standalone device . STUDENT OPTION 2 (CORRECT) You’re right, it is used with the current 2D mammography machine. QUINN RESPONSE 1 Yes, it is, I remember it because they were comparing the new machine to the same make and model of the one we have here at the Women’s Health Center. Response 1 kicks student back to options. QUINN RESPONSE 2 So, if it has to be used with what we already have, why do we need to buy it? Response 2 allows student to continue. Student must select correct option to continue. STUDENT OPTION 1 (CORRECT) Using a 3D mammography imager along with a traditional 2D machine increases the accuracy and allows u s to detect breast cancer at an earlier stage. STUDENT OPTION 2 (INCORRECT) It decreases the number of false positive readings from 10% to 5%. QUINN RESPONSE 1 Well, that’s a better outcome, I’ll give you that. Response 1 allows student to continue. QUINN RESPONSE 2 So, we reduce the number of overall tests a little bit? I don’t mean to sound callous, but this isn’t really an argument that will hold water by itself with the Board. Response 2 kicks student back to options. QUINN How much does it cost? STUDENT $500,000. Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 18 QUINN The Board will never approve it. At the last Board meeting, they voted down spending $275,000 on renovations for the canteen in the annex of the Center. Why do you think they’ll approve such a large capital expenditure o n such new technology? STUDENT I don’t really know if the plan has legs yet, I’m still trying to assess the situation. On -screen text: Ask Quinn a few questions about capital investments. Student must select all options before moving on. All Quinn Re sponses will kick back to the options until all are selected. STUDENT OPTION 1 How does the Board decide whether or not to make purchases like this one? STUDENT OPTION 2 What problems would you foresee with buying a 3D mammography machine? STUDENT OPTION 3 What questions do you want answered? STUDENT OPTION 4 I have to present ROI to the board. Any advice about how to get their attention ? QUINN RESPONSE 1 We bring in the CFO, in this case you, to explain to us why we need to buy something, why w e can’t do without it, and how much it’s going to cost us. Then, we decide if we agree with you. QUINN RESPONSE 2 The problem with any technology upgrades is that they become obsolete so quickly. What guarantees do we have that this technology won’t be history before we have the debt repaid? QUINN RESPONSE 3 The main question is this , if we buy the 3D machine, will we be required by new federal health care mandates to provide this service to everyone, or can we keep it as a premium service to pay down the cost of the machine? QUINN RESPONSE 4 They’re going to want to know how many patients we expect to use it each year and how much we’ll get from insurance reimbursements . Keep in mind that the board members aren’t all CFOs like you. So, m ake it clear how the income will exceed the cost . You probably won’t see any ROI in the first year, so I’d show an ROI analysis over the next five years. But don’t tell the Board that I’m helping you get us into debt. Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 19 STUDENT This is all very helpful, I’ll be sure to have a recommendation to you soon. QUINN Don’t thank me just yet, you haven’t gotten anything approved. Be sure to look at how much financing the project would cost in the long run and do a few different debt scenarios, ones that might make your ar gument easier to swallow. END SCENE 5 Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 20 Assessment If all previous scenes have been completed, a 10 -question assessment is presented to the student. Answer the following 10 questions to show what you know about health care ethics for equipment purchasing. Good luck! The student answers the questions and then sees the assessment results. Assessment Results Here are your results. Click Continue if you are satisfied with the result. Or you can click Try Again if you want to try and improve your score. NOTE: The student can retry the assessment by clicking the Try Again button, or can continue to final scene by clicking the Continue button. Health Care Ethics Navigate 2 Scenario : Equipment Purchase January 2, 201 8 21 Scene 6: Making Your Recommendation In this scene, the student will craft an email to the Board of Direct ors, with a recommendation. The recommendation will include each aspect of the analysis, as gathered from the staff. Location Chief Financial Officer’s Office Scene setup CFO is sitting at their desk. On -screen characters None Off -screen characters None On -screen text: After gathering information from key team members, it’s time to write your recommendation to the Board. On -screen text: Type your recommendation in the body of the email. Don’t forget, you can use the notes you’ve taken throughout yo ur interviews. Be sure to back up your recommendation with the analysis of the information gained from the team members. Also, don’t forget to briefly outline the key points of a change management plan corresponding to your recommendation. NOTE: An email a pplication open s. The “To:” section is filled with an email group description “Bright Road Board” and the subject is already filled in: “ CONFIDENTIAL: 3D MAMMOGRAPHY CAPITAL INVESTMENT.” NOTE: The student will be given an option to submit the email after writing it by clicking the "Send" button . After the student submits the email, the computer screen fades to the previous view of the student’s office. On -screen text: Congratulations! Your recommendation to the Board has been sent! FADE OUT THE END